Venous Ulcers Quiz 2

Question 1

Do deep or superficial veins have more valves?

Answer 1

Deep veins have more valves

Question 2

Name some of the deep veins in the lower extremity

Answer 2

Posterior tibial vein
Anterior Tibial Vein
Fibular Veins
Popliteal Veins
Femoral Vein
Deep Femoral Vein
External Iliac Vein

Question 3

What are the 3 types of veins in the lower leg?

Answer 3

Deep
Superficial
Perforator

Question 4

What is another name for the superficial venous system?

Answer 4

Saphenous System

Question 5

What are the 2 major vessels in the superficial venous system?

Answer 5

Greater Saphenous (longest vein in the body)
Lesser Saphenous (contains 9-12 valves)

Question 6

Are there more valves in the lower leg or upper leg?

Answer 6

Lower leg (helps fight against gravity)

Question 7

What is the purpose of the perforator veins?

Answer 7

Connect superficial to deep veins

Question 8

How many perforators are in the leg?

Answer 8

200 below the knee
20 above the knee
(varies greatly)

Question 9

How often are incompetent venous valves in perforating and superficial vessels found in patients with venous ulcers?

Answer 9

50-60%

Question 10

What are the 3 major mechanisms to help return blood to the heart through the venous system?

Answer 10

Smooth muscle tone in the vessel walls
Contraction of calf muscles
Negative intrathoracic pressure created during inspiration

Question 11

What’s the most important mechanism in returning blood to the heart?

Answer 11

Muscle pump
(pushes blood out of deep veins and into central circulation)

Question 12

Are the valves open or closed when the muscle relaxes?

Answer 12

Open (allow blood into deep system from superficial system)

Question 13

How does respiration help in blood return?

Answer 13

Movement of diaphragm creates a negative pressure in the chest

Question 14

What is ambulatory venous hypertension?

Answer 14

Sustained high pressure in low pressure veins (caused by retrograde flow from incompetent valves)

Question 15

What happens during ambulatory venous hypertension?

Answer 15

Unidirectional flow of blood becomes bidirectional
Edema builds up in the legs due to congested superficial veins
Deep veins aren’t completely emptied out creating an increased pressure

Question 16

What can improper functioning of the venous system lead to?

Answer 16

Chronic Venous Insufficiency

Question 17

What are the 2 possible mechanisms for chronic venous insufficiency?

Answer 17

Fibrin Cuff Theory

White Blood Cell Trapping Hypothesis

Question 18

What is the fibrin cuff theory?

Answer 18

Venous hypertension is transmitted to the superficial veins which causes widening of the capillary pores
Allows for large macromolecules to escape into interstitial space
Edema forms in the leg
Fibrin accumulates in the dermis and causes fibrin cuff (creates hard, non-pitting edema)

Question 19

What does the fibrin cuff create?

Answer 19

Mechanical border and lessens the delivery of oxygen and other nutrients to the skin

Question 20

What is the white blood cell-trapping hypothesis?

Answer 20

Transient elevation in the venous pressures decrease capillary blood flow, resulting in trapping of white blood cells at the capillary level
Trapping plugs capillary loops and results in areas of localized ischemia

Question 21

What is the enzymes that aid in cell death?

Answer 21

Proteolytic enzymes

Question 22

Which area of the lower leg has frequent problems with chronic venous insufficiency?

Answer 22

Medial Malleolus

Great saphenous vein has greatest curvature at this region

Question 23

What are some other factors that can cause venous ulcers?

Answer 23

Trauma to involved area

Infection

Question 24

What are the clinical indicators for CVI?

Answer 24

Localized limb pain (decreased with elevation, increased with leg dependency)
Pain with deep pressure or palpation
Pedal pulses are present
Increased temperature around the wound
Indistinct, irregular wound edges
Lower extremity edema
Shallow, fibrous covered wound bed, substantial drainage
Hemosiderin staining
Lipoderatosclerotic changes

Question 25

What are the scores you need with the wells score to predict a DVT?

Answer 25

> 1 indicates high probability (28% chance)

Question 26

What is lipodermatosclerosis?

Answer 26

Results from inflammation of the subcutaneous adipose tissue
Tissues become sclerotic over time
Skin becomes thick, hard, and onctracted with the inverted champagne-bottle appearance